Economic impact of treatment of HIV-positive pregnant women and their newborns with zidovudine. Implications for HIV screening
J. A. Mauskopf, J. E. Paul, D. S. Wichman, A. D. White and H. H. Tilson
Glaxo Welcome Inc., Research Triangle Park, NC 27709, USA.
OBJECTIVES--To estimate the economic impact of (1) treating pregnant women
who are human immunodeficiency virus (HIV)-positive with zidovudine and (2)
voluntary screening programs for pregnant women for HIV infection and
offering treatment with zidovudine to those found to be HIV-positive. MAIN
OUTCOME MEASURES--Number of cases of pediatric HIV infection and costs of
screening, zidovudine treatment, and pediatric HIV infection treatment.
DESIGN--Health care costs associated with treatment of HIV-positive
pregnant women and their newborns are estimated as the costs of zidovudine
and its administration and the reduction in costs of treating pediatric HIV
infection. The lifetime costs of pediatric HIV infection are derived from
the published literature. Estimates of the reduction in maternal-to-fetal
transmission rates are taken from the AIDS [acquired immunodeficiency
syndrome] Clinical Trials Group (ACTG) Protocol 076. Costs of a voluntary
screening program include costs of screening tests and counseling.
Sensitivity and threshold analyses are performed to determine the impact of
changes in input parameter values including zidovudine treatment costs,
efficacy of treatment, costs of pediatric HIV infection, prevalence of HIV
infection in pregnant women, screening test sensitivity and specificity,
and pregnancy termination rates on the results. RESULTS--Assuming
transmission rates are reduced from 25.5% to 8.3% as found in the ACTG 076
trial, treatment costs of $104,502 for 100 HIV-positive pregnant women and
their newborns are offset by the reduction of $1,701,333 associated with
fewer cases of pediatric HIV infection for a net savings of $1,596,831. The
sensitivity and threshold analyses show that overall cost savings from
treatment of HIV-positive pregnant women and their newborns are achieved
for a wide range of possible maternal treatment costs, efficacy rates, and
lifetime pediatric HIV treatment costs. In the base-case analysis for the
voluntary screening program, overall cost savings are seen when HIV
prevalence rate among pregnant women is greater than 4.6 per 1000. However,
this threshold prevalence rate is sensitive to changes In parameter
value-especially pediatric HIV treatment costs, counselling costs, efficacy
of treatment, and years of additional HIV treatment for the pregnant women.
CONCLUSIONS--Offering zidovudine treatment to pregnant women known to be
HIV-positive will decrease the number of cases of pediatric HIV infection
and reduce health care costs. Voluntary screening programs for pregnant
women will further decrease the number of cases of pediatric HIV infection.
The effect of a screening program on health care costs varies according to
HIV prevalence and the costs associated with the screening program.
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Mrus and Tsevat
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CHEN et al.
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Immergluck et al.
Pediatrics 2000;105:54e-54.
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Cost effectiveness analysis of antenatal HIV screening in United Kingdom
Ades et al.
BMJ 1999;319:1230-1234.
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POLANECZKY et al.
Obstet Gynecol 1999;94:647-652.
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STRINGER and ROUSE
Obstet Gynecol 1999;94:34-40.
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HIV Screening and Treatment of Pregnant Women and Their Newborns: A Simulation-Based Analysis
Anderson and Anderson
SIMULATION 1998;71:276-284.
ABSTRACT
